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Home My WebLink About1000-33.-2-47 IN TOWN OF SOUTHOLD E Rental Permit 1164 Owner 530 Washington LLC Occupied as Single Family Dwelling Located at 375 Green Hill Lane Greenport 33.-2-47 Maximum Permitted Occupancy 8 Is in compliance with all of the provisions of the code of the Town of Southold, the laws and sanitary and housing regulations of the County of Suffolk and by the laws adopted by the New York State Fire Prevention and Building Code Council. Expiration is two (2) years from date of issue. The operator is responsible for arranging for the bi-annual inspection. 7/5/2024 � � c� e Official This Notice must be posted by the main entrance at all times TOWN OF SOUTHOLD—BUILDING DEPARTMENT t Town Hall Annex 54375 Main Road P. O. Box 1179 Southold,NY 11971-0959 Telephone (631) 765-1802 Fax (631) 765-9502 htt s://") wee sOutlioldto nn ,,QQ RENTAL PERMIT APPL TION0 � � 1I Rental Permit Fee $300(Application must e en red every two eolldlog 0iutoV jQt&N Section A. �I Property Information: Rental Property Address: 375 Green Hill Lane Green port, NY 11944 Tax Map Number: 1000 SECTION 33 -BLOCK 2 -LOT 47 - SECTION B. OWNER INFORMATION: Property Owner Name: 530 Washington LLC Property Owner Legal Address: Property Owner Mailing Address: (Cannot be the same as Rental Property Address) 52 6th Avenue 52 6th Avenue Y 11217 Brooklyn, Y 11217 Telephone Number (s): Daytime 781-308-9888 Evening Emergency 949-413-2302 Property Owner Email Address: tze.chun@gmail.com 43(fib Page 1 of 4 Section C. Authorized Agent Information: Name of Authorized Agent of dwelling unit, if any: Tze Chun Address of Authorized Agent (no P.O. Boxes):, 52 6th Avenue Brooklyn n NY 11217 Mailing Address of Authorized Agent: 52 6th Avenue, Brooklyn NY 11217 Telephone Number (s): Daytime 781.308-9888 Evening Emergency Email Address: Section D. Managing Agent Information: Name of Authorized Agent of dwelling unit, if any: Address of Authorized Agent (no P.O. Boxes): Mailing Address of Authorized Agent: Telephone Number (s): Daytime Evening Emergency Email Address: SECTION E. SITE MANAGER INFORMATION: (required for rental properties containing 8 or more rental units) Name of Managing Agent of dwelling unit, if any: Address of Managing Agent (no P.O. Boxes): Mailing Address of Managing Agent: Telephone Number (s): Daytime Evening Emergency Email Address: Page 2 of 4 SECTION F. PROPERTY DESCRIPTION: Number of Rental Dwelling Units on property: 1 For each Rental Dwelling Unit set forth the Rental Dwelling Unit identifier (for example, Unit 1, Unit 2, Unit 3 or Apt A, B, Q the use of each room in the Rental Dwelling Unit (for example, Kitchen, Bedroom 1, Bedroom 2, Living Room) and the dimensions of each room. For properties with multiple Rental Dwelling Units use "Rental Permit Application Addendum." Rental Dwelling Unit Identifier: Unit 1 Requested Maximum number of persons allowed to occupy Dwelling Unit B Number of rooms in Rental Dwelling Unit: 11 ", Use and Dimensions of each room in Rental Dwelling Unit: Kitchen (15'x WE), B dro ' ro asBedroom 2 r x ro a rro a " RLlying Room ro sro n re x a DininopMn x 3 All ro. xro SECTION G. INSPECTION: Pursuant to the Town Code of the Town of Southold Chapter 207 (Rental Properties), a safety inspection by Code Enforcement Official is required. If the owner chooses not to have said inspection performed by the Town, a certification from a licensed architect, a licensed professional engineer or a home inspector who has a valid New York State Uniform Fire Prevention Building Code Certification is required stating that the property which is the subject of the rental permit application is in compliance with all of the provisions of the code of the Town of Southold, the laws and sanitary and housing regulations of the County of Suffolk and by the laws adopted by the New York State Fire Prevention and Building Code Council. p I am requesting a fire safety inspection to be performed by a Code Enforcement Official from the Town of Southold ❑ 1 am submitting a completed Town of Southold certification form from a licensed architect or a licensed professional engineer. Page 3 of 4 SECTION H. DECLARATION: Signature must be notarized and MUST be the owner of the dwelling unit. STATE OF NEW YORK) COUNTY OF SUFFOLK) Tze Chun, member of 530 Washington LLC 1 , certify under penalty of perjury,the following: 1. 1 am the owner of the property identified in "Section A" of this application. 2. The property owner's legal address set forth in "Section B" of this application is my legal address and I understand the Town will use the address for service pursuant to all applicable laws and rules. I further acknowledge that I will notify the Town of Southold Building Department of any changes of address within five (5) days of any changes thereto. 3. 1 have read and received a copy of Chapter 207 of the Code of the Town of Southold and agreed to abide by the same. 4. 1 will notify the Town within five (5) business days s to any change to the information regarding Authorized Agent, Managing Agent, or Site Manager. Property Owner's Name: Tze Chun member of 530 Washington LLC Property Owner's Signature: Sw before me this day of L C �"LOR �TWE OF NEW yoRK NOIARY PUBLIC, No. ITA 137"A17 Official Notary Public Signa re and Original Notary Stamp NassauCOU01 commission r 8,2096 Page 4 of 4 Town Hall Annex ' s Telephone (631)765-1802 54375 Main Road P. O. Box 1179 � Southold, NY 11971-0959 , BUILDING DEPARTMENT TOWN OF SOUTHOLD RENTAL PERMIT APPLICATION ADDENDUM Rental Dwelling Unit Identifier: Unit 1 Requested maximum number of persons allowed to occupy each dwelling unit: 8 Number of Rooms in Rental Dwelling Unit: 11 Use and Dimension of each room: Rental Dwelling Unit Identifier: Requested maximum number of persons allowed to occupy each dwelling unit: Number of Rooms in Rental Dwelling Unit: Use and Dimension of each room: Rental Dwelling Unit Identifier: Requested maximum number of persons allowed to occupy each dwelling unit: Number of Rooms in Rental Dwelling Unit: Use and Dimension of each room: " TOWN OF SOUTHOLD BUIEDl I a 631 -765-1802 1MV51PEE; ION [ ] FOUNDATION 1ST / REBAR [ ] ROUGH PTBG. [ ] FOUNDATION 2ND [ ] INS LATION/CAL [ ] FRAMING / STRAPPING [ ] INAL [ ] FIREPLACE & CHIMNEY [ FIRE SAFETY IN% [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PE [ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (Fit 10 [ ] CODE VIOLATION [ ] PRE C/O [ REMARKS: n --, I............. EASE At INSPECTOR I F I ZVI s I �3MEid 12 , y76 s e _#1 i w� � n AIR 5EALIN6 DETAILS AIR SEALING NOTES FOR—AL PRAMINC,DE—AIL f { ATM I 0 tALL JIM € n _ a ii �d H 7 H 1 at gg �a t SECOND FLOOR FLAN �[ U IGO= � 3 3 � 'rtr eob=race 1 U ga+J bae,sed € 1 Ws piace�wR�af mb� eawa h A.4G 1o5-3Ou. wa+ � �i muxm.w..two � moo, A-4 i SCTM # 4 TOWN OF SOUTHOLD PROPERTY RECORD CARS 1 OWNER STREET VILLAGE DIST_ SUB. ,/ LOT ID,4 ACR. REMARKS TYPE OF BLD. PROP. CLASS 5 3t = ` 1 LAND IMP. TOTAL DATE FRONTAGE ON WATER HOUSE/LOT BULKHEAD TOTAL a TOWN OF SOUTHOLD PROPERTY REC ` f a a �.. � - C� ' STREET VILLAGE DISTJ SUB LOT 4 Q ; } FORMR--dWNW N E - R s , R S W TYPE OF BUILDING RES. I® ° SEAS. j VL FARM COMM. CB. MICS, Mkt. Value - LAND IMP. TOTAL DATE REMARKS rl f . az b aT oo { 117- I y � 13 co f t L� AGE BUILDING CONDITION C I NEW NORMAL BELOW ABOVE i ` FARM Acre Value Per I Value Acre � � �� C Tillable FRONTAGE ON WATER Woodland I FRONTAGE ON ROAD Meadowland DEPTH House Plot i 1 BULKHEAD Total DOCK - LA a COLOR TRIM - : I , _ �� i 2 i a = I s F S ` ` a I a t a 33.-2-47 3/23/2021 I I � W4 61w I M. Bldg. 3 3 i S z F £ � 3 Extension Extension 's L Extension I Foundation Bath Dinette PorchBasement �� 'Floors I K. Porch 1 Sol 13 =Ext. Walls Interior Finish LR. B reezewa 5 y !Fire Place Heat �� QA DR. Garage S`7 S 1 "I' -Z ®Type Roof Rooms lst Floor ': BR. P s i , Recreation Room Rooms 2nd Floor �� /a`�0d ! FIN. B �— 4- v.) a W L9 O Q. B. Dormer jDriveway --------------------- Total ---------------- d i -—-—--------—-—- ------- Town of Southold 11/10/2020 P.O.Box 1179 53095 Main Rd Southold,New York 11971 ........... CERTIFICATE OF OCCUPANCY No: 41586 Date: 11/10/2020 THIS CERTIFIES that the building SINGLE FAMILY DWELLING ...................... ........- Location of Property: 375 Green Hill Ln, Greenport ....... ----......................... ................. SCTM#: 473889 Sec/Block/Lot: 33,2-47 Subdivision: Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated 12/30/2019 pursuant to which Building Permit No. 44617 dated 1/23/2020 ...... .... ...... .......... ................... was issued, and conforms to all of the requirements of the applicable provisions of the law. The occupancy for which this certificate is issued is: p.qq fan l glli ith -d baserngnt cover ftozLt g p)rob outdoor shower stall and atta woched t unfinishe oy gp2licd (.L The certificate is issued to Modem Age Builders LLC ........ ............. of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL R-19-0102 10/19/2020 ELECTRICAL CERTIFICATE NO. 44617 10/29/2020 ..................- PLUMBERS CERTIFICATION DATED 10/16/2020 r**%, es Sande . . . ............ th erg ignature c� Town of Southold 12/8/2020 P.O.Box 1179 53095 Main Rd Southold,New York 11971 CERTIFICATE; OF OCCUPANCY No: 41662 Date: 12/8/2020 THIS CERTIFIES that the building ELECTRICAL Location of Property: 375 Green Hill Ln., Greenport SCTM#: 473889 See/Block/Lot: 33.-2-47 Subdivision: Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated 11/4/2020 pursuant to which Building Permit No. 45411 dated 11/6/2020 was issued, and conforms to all of the requirements of the applicable provisions of the law. The occupancy for which this certificate is issued is: ele td1 J!pgr Ad „for e i s t i 4&—S inWl g,.P-0 L— The certificate is issued to Modem Age Blders LLC of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL ELECTRICAL CERTIFICATE NO. 45411 11/6/2020 PLUMBERS CERTIFICATION DATED _._....._.. _....................... _._. _..... ...._..____.__._.................._. U.. , - --_.�..w.-......__w_........... _._... Authorized Signature gr6Fdlt Town of Southold 8/14/2022 P.O.Box 1179 53095 Main Rd Southold,New York 11971 CERTIFICATE OF OCCUPANCY No: 43328 Date: 8/14/2022 THIS CERTIFIES that the building OTHER Location of Property: 375 Green Hill-Ln.,Greenport SCTM#: 473889 Sec/Block/Lot: 33.-2-47 Subdivision: Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated 11/9/2020 pursuant to which Building Permit No. 48063 dated 7/14/2022 was issued,and conforms to all of the requirements of the applicable provisions of the law. The occupancy for which this certificate is issued is: R The certificate is issued to Lewis Wmmmmmm eh Inter-Vivos Trt._µµµ of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL ELECTRICAL CERTIFICATE NO. PLUMBERS CERTIFICATION DATED r.i�. d tgraat....____. ww__.... ..... . ur FORM NO.4 TOWN OF SOUTHOLD BUILDING DEPARTMENT" Office of the Building Inspector Town Hall Southold,N.Y. Certificate Of Occupancy Z14100 Date December 18. . . . . . . . . . . . . . . . ., 19 85 THIS CERTIFIES that the building . . P o«01„ „ « w „ * . .„ . , « , , , , , , , . . . , . , , , Location of Property Green Hill Lane_ GreenQort. . . . . . . . . . . House No. Street . . . . . . Harr iei County Tax Map No. 1000 Section . 3 3 . . . . . . . .Block . . 2 . . . . . . . . . . .Lot . . . .4 7. . . . . . . . . . . Subdivision . , Eastern Shores, . . . . , , . .Filed Map No. 5 2 3 4. . ,Lot No. . . ?2.4 . . . . , . . conforms substantially to the Application for Building Permit heretofore filed in this office dated Sept ; 1 0 . , . . . . , , 19 89.pursuant to which Building Permit No. .1.085.8.Z . . . . . . dated . . , .S e t : 18. . „ . . „ , , . 19 8�. ,was issued,and conforms to all of the requirements of the applicable provisions of the law. The occupancy for which this certificate is issued is . . . . . . . . . Ing.round .poiol. .aOd. XeDc.e.. . . . . . . . . , . „ . . . . . . . . . . . . . . _ — . . . . . . . . . . . . . . . . . . . . . . . . . The certificate is issued to . . , , ELI ZABETH BRANDI of the aforesaid building. Suffolk County Department of Health Approval . „ . . . . . . . , .N/A« . . . « „ . . . . . . . . . . . . . . . . . . . UNDERWRITERS CERTIFICATE NO. . . . . . . . . . . . . . « . . . . 4 9 4 g, . . . . . . . . . . . « . . . . „ . L) a� «Building Inspector Rev.1/81